Physical Examination

Elevation of the foot and the application of ice at triage will facilitate the physical examination. The patient should be examined on a stretcher. Examination of the foot includes an ankle examination (see Chap 268, "Ankle Injuries"). The foot should be inspected for any loss of skin integrity, for deformity, and finally for swelling and ecchymosis. Passive range of motion should be assessed and compared with the uninjured foot. Palpate the achilles tendon, the calcaneum, the dorsum of the midfoot, and then the metatarsals and phalanges. Pay special attention to the base of the fifth metatarsal and the area over the base of the second metatarsal. Actively move the various joints of the foot through their range of motion. Next, grasp two adjacent metatarsal heads and move them in opposite dorsiplantar directions. Finally, if the foregoing exam does not suggest a specific injury, observe the patient ambulating. Normal findings on examination and the ability to complete several weight transfers to the injured foot essentially excludes a significant injury.

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